Extensor Indicis Tendon Research Articles

An extensor digitorum brevis manus coexisting with the typical extensor indicis muscle: a rare dissection finding.

The forearm extensor muscle and hand extensor tendons are composed of several structures with unique anatomy identified with high morphological variability. During a routine dissection of a 74-year-old donated male cadaver, the right hand was isolated for educational purposes. After carefully dissecting the structures, an accessory muscle was identified. The accessory muscle corresponded to the extensor digitorum brevis manus (EDBM) inserted into the extensor indicis (EI) tendon, which was typically identified. According to the current literature, this occurrence corresponds to a rare variant, with 0.36-0.38% prevalence between the cadaveric studies. Knowledge of the hand extensor musculature is essential for orthopedics and plastic surgeons operating in the region to avoid iatrogenic injury.

Presumed Presence of Extensor Indicis et Digiti Medii Communis Muscle in a 70-Year-Old White Male Donor

Forearm extensor muscle variations can be diverse and, in some instances, rare. During a routine anatomical dissection of human cadaveric donors during the 2021 first-year medical gross anatomy course and 2021 graduate nursing advanced anatomy course at the Uniformed Services University of the Health Sciences, bilateral agenesis of the extensor carpi ulnaris muscle was noted in one 70-year-old white male donor. This variation is described as extremely rare in the literature. The presence of an extensor indicis et digiti medii tendon, a variant of the extensor indicis tendon, appeared to be evident in post-dissection photographs on the left hand. The presence of a duplicated extensor indicis proprious tendon appears to be evident on the right hand. However, further inspection of this region was impeded as the body was sent for cremation prior to the variation being identified. The presence of various juncturae tendinum was also noted bilaterally. Reported prevalence of extensor indicis muscle variants ranges from 0.75% to 13%, depending on the specific type or grouping of variations observed. Knowledge of variations in the extensor compartment of the forearm and wrist is crucial for orthopedic surgeons and specialists. Alteration of surgical approaches may be necessary if such a variation is present. Such variations can be options for grafts, resulting in minimal functional change to the grafted area due to the continued existence of other muscles performing similar functions. Knowledge of such variations, and alternative, synonymous names for them, is also important for anatomy instructors, who may need to assist students in identifying these rare variations during anatomical dissection.

Long-Term Results of Extensor Indicis Transposition Following Rupture of the Extensor Pollicis Longus Tendon after Paediatric Forearm Fracture

A rare but typical perioperative complication in the surgical treatment of pediatric forearm fractures is injury to the extensor pollicis longus (EPL) tendon. This article presents the long-term results after reconstruction of the EPL tendon with transposition of the extensor indicis (EI) tendon in children and adolescents after surgically treated forearm fracture. Over a period of 15 years, 22 children up to the age of 16 were treated with EI transposition analogous to adult care. In a follow-up examination, the range of motion of the finger and thumb joints, retropulsion of the thumb and index finger, abduction and opposition were examined. In addition, hand span and strength in the gross, key, and point grasp were measured. Subjective complaints were questioned and the DASH score was assessed. Rupture of the EPL tendon is a rare complication, accounting for 1% of all surgically treated paediatric forearm fractures. 15 patients with an average age of 10.9 years could be followed up for an average of 66.5 months after transposition of the EI tendon. Significant differences were found in reduced mobility of the metacarpophalangeal joint of the thumb, isolated extensor strength of the index finger, a reduced span between the thumb and index finger in palmar abduction, and reduced strength in the pointed grip. Subjectively, the differences between the sides were not noticed by the patients and their parents in everyday life. Transposition of the EI tendon for reconstruction of a ruptured EPL tendon as a rare complication after paediatric forearm fracture does lead to a measurable and significant reduction in index finger mobility on the affected side in the long term, but without subjective limitations of the children.

Optimal recording electrode placement for radial motor nerve conduction study using extensor indicis muscle: Cadaver and electrophysiological studies.

The aim of this study was to determine the optimal combination of active (E1) and reference (E2) recording electrode placements for the radial motor nerve conduction study recording over the extensor indicis muscle using surface electrodes. Thirty-six upper limbs from 18 fresh frozen cadavers were dissected to determine the midpoint of the extensor indicis muscle. Radial nerve conduction study was performed in 112 arms of 56 healthy subjects. Six combinations of three E1 and two E2 sites were studied. The stimulation site was 8cm proximal to the E1 electrode. The optimal combination of placement sites for the E1 and E2 electrodes to provide the largest amplitude is E1 electrode at the distal 1/4 point of the forearm length and E2 electrode at the extensor indicis tendon point in the wrist. Optimal recording electrode placement may increase the accuracy and reproducibility of radial motor nerve conduction studies.

Simplified active motion protocol following Extensor indicis to Extensor pollicis longus tendon transfer using a side-to-side suture

Ruptures of the Extensor pollicis longus tendon are commonly treated by Extensor indicis transfer using Pulvertaft suture technique. Current literature does not yet give evidence for a preferable post-operative therapy protocol. A side-to-side suture technique is significantly stronger than the Pulvertaft repair technique and therefore allows an immediate active postoperative treatment. We present a new postoperative protocol, which is simple, fast and safe, and should make treatment easier for patients and therapists. We treated 10 patients with a transfer of the extensor indicis tendon between 07/2016 and 08/2017 according to the new active protocol. Patients were seen for follow-up at 2, 4 and 8 weeks. Thumb range of motion, pinch and grip strength as well as subjective parameters like pain and general satisfaction were measured. All patients regained full function of their thumbs with retropulsion over the level of the palm at 4 weeks. Median pinch strength was 89 % and grip strength 74 % of the contralateral side at week 4. There was no secondary rupture of the reconstructed tendon over a one-year period. All patients were satisfied with the result of the operation and the protocol. Our new active postoperative protocol for extensor indicis transfer using a side-to-side suture has proven to be safe and less strenuous for patients and therapists and has been established as standard treatment in our clinic.

Rare Bilateral Variation of the Extensor Indicis Tendon in two Female Cadavers

In this case study, we discuss the observed anatomical variant of bilateral extensor indicis medii communis (EIMC) muscle. During a routine anatomical dissection of 48 upper limbs from 24 cadavers, two female cadavers (75 and 79 years of age) demonstrated bilateral EIMC (8.3%), while one male cadaver (86 years of age) demonstrated unilateral EIMC (4.2%). The noted EIMC shared a muscle belly with the extensor indicis, but had a distal attachment in the extensor hood of the third digit. This is a rare instance of a bilateral presentation of the extensor indicis medii communis muscle. There has been a limited number of cases in which a bilateral EIMC was discovered; however, such findings have been limited to one cadaver and at a lower frequency. This finding may demonstrate that bilateral EIMC may not be as rare as previously thought. Ultimately due to its infrequency, awareness of this variation may help physicians avoid improper muscle recognition when visualizing the area during procedures regarding the dorsum of the hand, as well as providing a possible site of tendon harvesting.

A new technique to determine the tension in extensor pollicis longus reconstruction.

We present an original technique for determining the tension of the extensor pollicis longus tendon after reconstruction. We treated 20 patients using this technique for an extensor pollicis longus tendon graft or extensor indicis tendon transfer and reviewed the results. The tension of the reconstructed extensor pollicis longus was adjusted so that the centre of the distal edge of the thumbnail was elevated 2 cm above the operation table. The mean retropositional distance of the treated thumbs was 1.2 cm less than the contralateral thumbs. The mean total active motion of the thumb was 90%. This technique resulted in satisfactory thumb function. Level of evidence: IV.

Variant Superficial Branch of Radial Artery along with Supplementary Tendons on the Dorsum of the Hand and Their Surgical Implications.

Variations of radial artery, in both its course and branching pattern in the anatomical snuffbox, are clinically significant for the plastic surgeons, cardiologists, and radiologists. Reports on its abnormal high origin and subsequent superficial course have been well documented. Herein, we report an unusual superficial branch of the radial artery given off before its entry into the palm by passing between the two heads of first dorsal interosseous. It eventually divided into princeps pollicis and radialis indicis arteries at the first web space of palm as a unique vascular variation. Apart from this, in the present case, the tendon of extensor digiti minimi and of extensor indicis divided into two parts. The split tendons of extensor digiti minimi were inserted to the dorsal digital expansion of the digitus minimus. However, lateral tendon of split extensor indicis was inserted along with the tendon of extensor digitorum to the index finger and the medial one was inserted along with the tendon of extensor digitorum to the middle finger. Unusual superficial branch of radial artery on the dorsum of the hand is vulnerable for an iatrogenic injury during surgical approaches in the region. Supplementary extensor tendons on the hand are one of the potential causes for the tenosynovitis.

The prevalence of the extensor indicis tendon and its variants: a systematic review and meta-analysis.

The tendon of the extensor indicis (EI) is frequently used to restore the loss of function in other digits. However, it shows many variations which include splitting of the extensor indicis proprius (EIP) into two or three distal slips, attachment to fingers other than the index such as the extensor medii proprius (EMP), attachment onto the index and the third finger such as the extensor indicis et medii communis, or attachment to both the index and the thumb such as the extensor pollicis et indicis (EPI). This systematic review gathers the available data on the prevalence of EI tendon and its variation in the hand. Twenty-nine cadaveric studies met the inclusion criteria with a total of 3858 hands. Meta-analysis results yielded an overall pooled prevalence estimate (PPE) of EI of 96.5% and PPEs of 92.6, 7.2 and 0.3% for the single-, double- and triple-slip EIP, respectively. The single-slip EIP is frequently inserted on the ulnar side of the extensor digitorum communis of the index (EDC-index) in 98.3%. The double-slip EIP is located on the ulnar side of the EDC-index in 53.5%, on its radial side in 17% and on both sides in 28.7%. Indian populations showed the highest rate of single-slip EIP and the lowest rate of double-slip EIP when compared to Japanese, Europeans and North Americans. The pooled prevalence of EMP, EMIC and EPI were 3.7, 1.6 and 0.75%, respectively. Knowledge of the variants of the EI tendon and their prevalence should help surgeons in correctly choosing the tendon to transfer in hand surgery.

Study of morphology, phylogeny, classification and clinical relevance of extensor digitorum brevis manus

Introduction and objectives : Variations in structures of hand are of clinical and surgical importance. A rare variation of the extensor musculature on the dorsum of hand is extensor digitorum brevis manus (EDBM). Presence of EDBM on the dorsum of hand can be confused for many dorsal hand mass lesions. In the present cadaveric study, an attempt was made to delineate the anatomical morphology and morphometry of EDBM and evaluate its phylogenetic significance and clinical relevance. Methodology: Study was conducted on 78 human hands in the department of anatomy. A longitudinal incision was performed on the dorsum of hand along the axis of middle finger, skin flaps were raised both on radial and ulnar side. A transverse incision was taken at metacarpophalangeal joints from second to fifth fingers. Results: We found EDBM in two incidences. In both the cases it was extending from the distal end of radius, dorsal aspect of wrist joint and from the extensor indicis tendon. Muscle was medial to extensor indicis tendon. Insertion was into the dorsal digital expansion of middle finger. In both the cases it was classified as type III anatomical variety. Conclusion: Appreciation of such variant muscle on the dorsum of the hand is of great significance during clinical and surgical evaluation of mass lesions on the dorsum of hand. Key words: Extensor digitorum brevis manus; dorsum of hand; variations.

Closed rupture of the extensor indicis tendon: An unusual cause of swelling over the dorsum of the hand

Closed rupture of the extensor indicis tendon: An unusual cause of swelling over the dorsum of the hand

Extensor pollicis longus rupture after distal radius fracture: Results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting

Injury of the extensor pollicis longus tendon is one of the commonest extensor tendon injuries after distal radius fracture. In 2003-2005 we performed extensor indicis transfer in 31 patients with loss of function of the EPL tendon and postoperative dynamic splinting. In 25 patients, a distal radius fracture managed surgically led to the EPL rupture (wire internal fixation in 23 patients, plate internal fixation in 2 patients). In 6 patients, the cause was a distal radius fracture treated conservatively. Out of our 25 followed-up patients, 9 (36%) had a very good and 15 (60%) a good result in the Geldmacher score. We did not identify any re-rupture. In injuries of the extensor pollicis tendon, transposition of the extensor indicis tendon is a simple and uncomplicated procedure. Considerable improvement of thumb extension can be achieved through this substitution repair.

Vergleich der Ergebnisse nach Rekonstruktion der Sehne des Musculus extensor pollicis longus durch freies Sehneninterponat gegenüber dem motorischen Ersatz durch eine Extensor indicis-Transposition

Is there a difference in the results of free tendon grafting or transfer of the extensor indicis tendon for the reconstruction of the extensor pollicis longus tendon? Two groups of patients, who underwent surgery between 1992 and 1998, were compared. From 58 patients with tendon grafts 48 were re-examined. For reconstruction, a graft harvested from the palmaris longus tendon was applied that was woven into the proximal and distal stump of the extensor pollicis tendon according to the technique of Pulvertaft. From 56 patients with transfer of the extensor indicis tendon, 40 were re-examined. The extensor indicis transfer was performed by the standard technique. Extension and flexion of the metacarpophalangeal and interphalangeal joints of the thumb, retroposition, abduction and opposition were examined. In addition, the span of the hand, grip strength and pinch strength were measured. A summarising assessment was performed according to the Geldmacher score, the subjective impairment was assessed by the DASH score. Both groups were comparable according to demographic data and aetiology of the rupture. The range of motion was nearly identical after both surgical techniques. Range of motion of the joints of the thumb, abduction and opposition reached normal values but both methods restored only 60 % of the normal retroposition. According to the Geldmacher score, both methods showed good and excellent results. The DASH score resulted in low values with 10 and, respectively, 14 points. After extensor indicis transfer all patients demonstrated isolated extension of the index. Both methods establish equally good results. Free tendon grafting is technically more demanding but preserves a more powerful isolated extension of the index finger and should, therefore, be preferred in patients with special demands on this function (e.g., musicians). The transfer of the extensor indicis tendon is technically less demanding, requires retraining and may impair the isolated function of the index finger.

Die frühaktive Nachbehandlung nach Extensor indicis-Sehnentransposition - Eine prospektiv randomisierte Studie

We conducted a prospective randomised trial to compare the postoperative results and complications following two postoperative treatment protocols (dynamic motion vs. early active motion) after transfer of the extensor indicis tendon. 21 patients (10 female, 11 male) were randomly assigned to two treatment protocols after transfer of the extensor indicis tendon. In one group of patients ("dynamic"), the reconstructed tendon was extended passively with a rubber band system, in the other study group ("active"), early active extension of the thumb was initiated. Active range of motion in the interphalangeal (IP) and metacarpophalangeal joints (MP) as well as grip and pinch strength were evaluated after the third, fourth, sixth and eighth postoperative week. All complications during the first postoperative year were noted. Statistical analysis was performed with chi-square and Mann-Whitney U-tests. After the eighth postoperative week, in the IP joint an average range of motion of 69 degrees (45-110 degrees) was found in the dynamic study group and 58 degrees (40-75 degrees ) in the active study group. After three weeks, patients treated with the dynamic treatment protocol demonstrated significantly (p=0.03) greater ranges of motion, during the further treatment course no significant differences between the two groups were detected. After eight weeks, the average grip and pinch strength was 66 %/73 % of the contralateral side in the dynamic study group and 63 %/71 % in the active study group. With respect to the small groups of patients, both treatment protocols demonstrate comparable clinical results after 8 weeks. Early active motion does not result in a higher rate of complications but fails to speed up rehabilitation.

Endoscopic Single-incision Extensor Indicis Transposition for Extensor Pollicis Longus Reconstruction

Traditional methods for harvesting the extensor indicis (EI) tendon for transposition to the extensor pollicis longus (EPL) tendon using direct visualization commonly require 3 incisions. The authors describe an endoscopic EI tendon transposition for EPL tendon reconstruction as an alternative technique for the traditional open technique. This new modification of endoscopic EI transposition to EPL has the benefit over the standard harvesting technique of only 1 incision to accomplish the complete procedure and results in less scarring. To date, the authors have only operated on ruptures after radius fractures without significant synovitis in the area of the extensor compartment.

Four cases of variations in the forearm extensor musculature in a study of hundred limbs and review of literature

ABSTRACTAll surgeons must bear in mind the existence of muscular variations when performing common tendon transfers. Presence of additional bellies and tendons of existing muscles or presence of additional muscles in unusual locations might misguide a surgeon, during surgery and also during diagnosis. In the present paper we are reporting four cases of variations encountered during the study of extensor muscles of the forearm in 100 limbs. In Case 1, additional bellies of extensor carpi radialis longus and extensor carpi radialis brevis and multiple tendons of insertion of abductor pollicis longus were observed in a single limb. In Case 2, an additional belly of the abductor pollicis longus was observed. In Case 3, a short muscle on the dorsum of the hand going to the index finger [extensor indicis brevis (EIB)] was found in addition to the normal extensor indicis (EI). It was also observed that some of the most superficial fleshy fibers of EIB were getting inserted into the tendon of EI. In Case 4, a rare incidence of extensor digiti medii proprius was observed. Further, the related literature is reviewed and the clinical and surgical importance of these muscular variations in diagnosis and proper planning of treatment is discussed.

The Compound Dorsal Metacarpal Artery Tendofasciocutaneous Flap

Different modifications of flaps based on the dorsal metacarpal arterial system have been reported as reliable tools for reconstruction of dorsal and palmar phalangeal soft tissue defects. For simultaneous reconstruction of the extensor aponeurosis and joint in complex injuries of the dorsal index, we used a distally based pedicled fasciotendocutaneus second dorsal metacarpal flap, including the complete vascularized extensor indicis tendon in 2 cases. Clinical results of this procedure have not been reported so far.

Four cases of variations in the forearm extensor musculature in a study of hundred limbs and review of literature

All surgeons must bear in mind the existence of muscular variations when performing common tendon transfers. Presence of additional bellies and tendons of existing muscles or presence of additional muscles in unusual locations might misguide a surgeon, during surgery and also during diagnosis. In the present paper we are reporting four cases of variations encountered during the study of extensor muscles of the forearm in 100 limbs. In Case 1, additional bellies of extensor carpi radialis longus and extensor carpi radialis brevis and multiple tendons of insertion of abductor pollicis longus were observed in a single limb. In Case 2, an additional belly of the abductor pollicis longus was observed. In Case 3, a short muscle on the dorsum of the hand going to the index finger [extensor indicis brevis (EIB)] was found in addition to the normal extensor indicis (EI). It was also observed that some of the most superficial fleshy fibers of EIB were getting inserted into the tendon of EI. In Case 4, a rare incidence of extensor digiti medii proprius was observed. Further, the related literature is reviewed and the clinical and surgical importance of these muscular variations in diagnosis and proper planning of treatment is discussed.

Volar Versus Dorsal Plating in the Management of Intra-Articular Distal Radius Fractures

To compare the complications and functional and radiographic outcomes of volar and dorsal plating of intra-articular distal radius fractures. This retrospective review included 34 patients found by searching a database of 350 patients treated for distal radius fractures. Inclusion criteria were (1) at least 1 year of follow-up data and (2) open reduction and internal fixation of a multifragmentary fragment intra-articular distal radius fracture with either a nonlocking volar or dorsal plate. Twenty patients were treated with a dorsal plate and 14 patients were treated with a volar nonlocking plate. Objective and subjective outcome parameters were compared between the 2 groups. Objective evaluations included wrist range of motion, grip strength, and preoperative and postoperative radiographic parameters (radial inclination, palmar tilt, ulnar variance, fracture pattern). Subjective evaluations were performed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score and the Gartland and Werley score. Volar plating resulted in a significantly better Gartland-Werley score compared with dorsal plating. There were no significant differences in the DASH score. Volar collapse was documented in 5 of the 20 patients in the dorsal plating group, which resulted in a mild loss of pronation compared with the volar plating group. No collapse occurred in the volar plating group. In addition the difference in the percentage of wrist range of motion compared with the contralateral wrist was not significant. Dorsal plating was associated with a ruptured extensor indicis tendon in 1 patient; secondary surgical procedures were required in 4 patients (tenolyses and radial styloidectomy). Volar plating was associated with median nerve neuropathy in 2 patients and intersection syndrome in one. Although both groups of patients had similar DASH scores the functional outcome in terms of Gartland and Werley scores was better in the volar plating group. In addition there was a higher rate of volar collapse and late complications in the dorsal plating group compared with the volar plating group. Therapeutic, Level III.

Strecksehnenrupturen nach winkelstabiler palmarer Plattenosteosynthese distaler Radiusfrakturen

Fingerstrecksehnenverletzungen nach palmarer Plattenosteosynthese einer distalen Radiusfraktur bei eigenen und nachbehandelten Patienten führten zur Untersuchung der Ursachen dieser Schädigung. Nach einer Mindestbeobachtungszeit von 3 Monaten konnten bei 119 distalen instabilen Radiusfrakturen nach palmarer Plattenosteosynthese 5 Strecksehnenrupturen beobachtet werden. Vier der fünf Strecksehnenrupturen sind sehr wahrscheinlich auf Sehnenverletzungen durch die Plattenosteosynthese zurückzuführen. Eine der fünf Strecksehnenrupturen ist Folge einer mechanischen Irritation bei sehr engem Strecksehnenfach und zeigte keinen Kontakt zum Implantat. Alle Frakturen heilten ohne weitere Komplikationen zeitgerecht aus. In allen Fällen erfolgte eine operative Revision des betroffenen Strecksehnenapparates. Strecksehnenverletzungen sind nach palmarer winkelstabiler Plattenosteosynthese im eigenen Patientenkollektiv eine relativ häufige Komplikation (4,2 %). In der Literatur sind nur wenige Fälle von Strecksehnenverletzungen nach palmarer Plattenosteosynthese beschrieben worden. Häufigste Ursache von Strecksehnenläsionen war die Sehnenverletzung durch dorsal herausragende Gewinde der Osteosyntheseschrauben. Zur Vermeidung sekundärer Strecksehnenrupturen ist neben einer vorsichtigen Bohrung der knöchernen Fragmente und einer korrekten Schraubenlänge eine zeitgerechte Materialentfernung nach Frakturkonsolidierung zu erwägen.